Pathology.—The lesions resulting from this disease may be divided into two parts. First, the lesions of the intestinal canal, Peyer's patches, the solitary glands of the ileum and caecum, and more rarely of the colon and the rectum, and changes in the spleen. Secondly, those lesions resulting from sepsis occurring during the long period of fever, and affecting the tissues and organs at large. The first effect of the poison or bacilli is to cause hyperemia (swelling) of the lymphatics, the capillaries become engorged and cell infiltration takes place in the solitary glands of the intestines. Frequently the infiltration is so excessive that the capillaries become engorged and entirely choked with the infiltration. Ulcers form, which are shallow or deep, according to the amount of necrosis (sloughing), and when very deep, perforation of the bowel may follow, although this condition is rare. The spleen is nearly always involved, congestion takes place, followed by softening. The liver becomes hyperemic, swollen and soft, and often shows abscess formation. There is granular degeneration in the kidney, ulceration of the larynx and sometimes congestion of the lung. The heart muscles too often become weakened the result of the poison.
Treatment.—If death occurs early in the disease, the body will not be greatly emaciated, and the following treatment may be followed in detail:
If intense abdominal fermentation exists, relieve the accumulated gas with trocar, aspirate as much serous matter as possible from the pelvic cavity, introduce a strong fluid into the cavity, taking care to have as much of this fluid reach the cavities of the intestines as possible. Open one of the arteries commonly used in one of the drainage processes and inject 64 ounces of half strength fluid, draining blood from the vein simultaneously with the injection. Then inject a sufficient quantity of normal fluid to complete preservation. Close all openings of the body with absorbent cotton. Massage the face with water or a commercial solution during the injection.
If death occurs late in the disease, the abdomen may require a stronger treatment such as we would give in acute peritonitis. The trocar may not prove efficient in reaching the affected parts and in such a case we would make a 4 inch incision along the median line and between the umbilicus and the pubic arch, exposing the ileum and caecum, which should be incised, their contents removed, and then all replaced in the cavity thoroughly surrounded with hardening compound. After this the wound should be closed with stitches. After preservation has been completed in either this form of the disease or the one mentioned above, dust on a good quality of face powder to remove the moist appearance from the skin. When a body dead of this disease is to be transported, consult the state or local transportation rules in addition to these treatments.
Leprosy.
—Definition.—A chronic, infectious, contagious disease, which usually terminates fatally.
Cause.—The bacillus leprae. There are tuberculous growths in the skin, which push outward, form nodular masses, between which are seen areas of ulceration and cicatrization, which in the face, distort the features. These tubercular masses discharge a thick purulent material. The destruction of tissue proceeds gradually, years being occupied in destroying a patient. The deep, ulcerative process may amputate fingers and toes in its progressive march.
Treatment.—The body is rarely presentable for sometime before death, and this should not be a consideration in our treatment. If an arterial injection is possible, give it, using normal fluid for the injection. Work with rubber gloves. Give a complete cavity injection. Wrap the body in absorbent cotton and then in a sheet. For transportation, govern yourself according to the provisions of the transportation rules.
Influenza.
—Synonyms.—Epidemic catarrhal fever; la grippe.